Liz Stirling and Jacqueline Tetroe

1. Knowledge Translation at the Canadian Institutes of Health ResearchNCDDR Web cast December 6, 2006 Liz Stirling and Jacqueline Tetroe

2. Outline for the discussion • Knowledge Translation at CIHR • Definitions, purpose and rationale for knowledge translation • How widely can the concept of knowledge translation be applied? • But what does KT really mean? • Knowledge to Action – Graham et al 2006 • Knowledge Translation – good in theory - how can it work in practice? • How to measure the impact of Knowledge Translation • Moving knowledge to action: Best practice for wound care 2

3. Outline for the discussion • Knowledge Translation at CIHR • Definitions, purpose and rationale for knowledge translation • How widely can the concept of knowledge translation be applied? • But what does KT really mean? • Knowledge to Action – Graham et al 2006 • Knowledge Translation – good in theory - how can it work in practice? • How to measure the impact of Knowledge Translation • Moving knowledge to action: Best practice for wound care 3

4. Knowledge Translation at CIHRDefinitions, purpose and rationale for knowledge translation Knowledge translation is the exchange, synthesis and ethically-sound application of knowledge - within a complex system of interactions among researchers and users - to accelerate the capture of the benefits of research for Canadians through improved health, more effective services and products, and a strengthened health care system 4

5. Knowledge Translation at CIHRDefinitions, purpose and rationale for knowledge translation • Context for the CIHR definition • As described in the CIHR Act, knowledge translation is a broad concept. It encompasses all steps between the creation of new knowledge and its application to yield beneficial outcomes for society. This includes knowledge dissemination, communication, technology transfer, ethical context, knowledge management, knowledge utilization, two-way exchange between researchers and those who apply knowledge, implementation research, technology assessment, synthesis of results within a global context, development of consensus guidelines, and more. 5

6. Knowledge Translation at CIHRDefinitions, purpose and rationale for knowledge translation • Key point is that interactions between researchers and stakeholders may vary in intensity, complexity and level of engagement depending on the nature of the research results and on the needs of the particular stakeholder. 6

7. Knowledge Translation at CIHRDefinitions, purpose and rationale for knowledge translation • What is NOT KT? • For example, KT is NOT: • Continuing Medical Education • Continuing Professional Development • Translational Research 7

8. Knowledge Translation at CIHRDefinitions, purpose and rationale for knowledge translation • What is Continuing Medical Education? • CME generally refers to planned educational activities intended to further the education and training of specific health professionals for the enhancement of practice, education, administration and research or Professional Development 8

9. Knowledge Translation at CIHRDefinitions, purpose and rationale for knowledge translation • What is Continuing Professional Development? • This includes educational methods beyond the didactic, embodies concepts of self-directed learning and personal development and considers organizational and system factors 9

10. Knowledge Translation at CIHRDefinitions, purpose and rationale for knowledge translation • What is Translational Research? • Translational research is about finding solutions to clinical problems. Ideally it involves two way interactions between basic/fundamental scientists and clinicians and requires moving between scientific discoveries and clinical applications 10

11. Knowledge Translation at CIHRDefinitions, purpose and rationale for knowledge translation • The distinction between translational research and KT is that KT is the next step in the process - the widespread dissemination of the clinical application once it has been proven beneficial by clinical research would be considered KT (i.e. translational research ends with the development and/or testing of the clinical application and does not include its widespread promotion). 11

12. Knowledge Translation at CIHRDefinitions, purpose and rationale for knowledge translation The rationale for KT: • Creation of new knowledge often does not, by itself, lead to its widespread adoption or impact health • Increased emphasis on research governance and accountability from many levels: federal and provincial government, as well as the public 12

13. Knowledge Translation at CIHRDefinitions, purpose and rationale for knowledge translation • The mandate of CIHR includes KT: • To excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system." • To move research into practice/action and ultimately, • To improve the health of Canadians. 13

14. Knowledge Translation at CIHRDefinitions, purpose and rationale for knowledge translation • Historical perspective of KT in Canadian Health funding organizations: • The Alberta Heritage Foundation for Medical Research started to identify the need in the early 1990’s, using the term “research in practice” – and developed a model • The Canadian Health Services Research Foundation– founded in 1996 – focused on linkage and exchange and knowledge brokering and brought these concepts into academic forums • Change from MRC to CIHR in 2000 – KT became part of the mandate 14

15. Outline for the discussion • Knowledge Translation at CIHR • Definitions, purpose and rationale for knowledge translation • How widely can the concept of knowledge translation be applied? • But what does KT really mean? • Knowledge to Action – Graham et al 2006 • Knowledge Translation – good in theory - how can it work in practice? • How to measure the impact of Knowledge Translation • Moving knowledge to action: Best practice for wound care 15

16. How widely can the concept of knowledge translation be applied? • KT is an issue at the local, national and international level • What distinguishes the levels is the end user/target audience • The process is essentially the same at each level • The impact of KT can filter up or down the levels • In our view, we need to link globally and act locally 16

17. How widely can the concept of knowledge translation be applied? • KT is not unique to medical research • The concept has been used in many other disciplines – and is known by other names: technology transfer, knowledge management, change management etc. • The process that is KT is appropriate to any discipline – it is about facilitating the uptake of research • While the process is universal, the content/context does vary 17

18. Outline for the discussion • Knowledge Translation at CIHR • Definitions, purpose and rationale for knowledge translation • How widely can the concept of knowledge translation be applied? • But what does KT really mean? • Knowledge to Action – Graham et al 2006 • Knowledge Translation – good in theory - how can it work in practice? • How to measure the impact of Knowledge Translation • Moving knowledge to action: Best practice for wound care 18

19. But what does KT really mean? • How does the term KT differ from the term research utilization? • Depends on how one defines :”research” and on how one defines “knowledge” • We think of research as a subset of knowledge • We are not getting involved in the debate over the definition of “evidence”1 1 See, for example: Conceptualizing and combining evidence for health system guidance. http://www.chsrf.ca/other_documents/evidence_e.php 19

20. But what does KT really mean? • Knowledge translation versus research utilization continued • Starting in the early 1970s, research utilization was the term used to describe the incorporation of research evidence into clinical practice. • Since then, many nursing models of research utilization have been developed. 20

21. But what does KT really mean? • What is meant by research utilization? • A term used predominantly by the nursing professions • The definition has become more precise over time • A process of using findings from conducting research, to guide practice – Titler et al 1999 • The process by which scientifically produced knowledge is transferred to practice – Brown 1999 21

22. But what does KT really mean? • Definition of research utilization continued • The use of research findings in any and all aspects of one’s work as a registered nurse – Estabrooks 1998 • Process by which specific research-based knowledge (science) is implemented in practice - Estabrooks 2003 • A specific kind of knowledge utilization whereby the knowledge has a research base to substantiate it. It is a complex process in which knowledge, in the form of research, is transformed from the findings of one or more studies into instrumental, conceptual, or persuasive utilization - Estabrooks 2006 22

23. But what does KT really mean? • Research utilization • Evidence based practice • Moving knowledge to practice • Knowledge to action • The specific words used are not important per se – what is important is how these terms are operationalized 23

24. But what does KT really mean? • Research utilization • Evidence based practice • Moving knowledge to practice • Knowledge to action • Ian Graham, CIHR Vice President of Knowledge Translation, uses the term “knowledge to action”2 • Knowledge to action is an organic process with defined steps - it is a process 2 Graham, I.D., Logan, J., Harrison, M., Straus, S., Tetroe, J.M., Caswell, W. and Robinson, N. 2006. Lost in translation: Time for a map? Journal of Continuing Education in the Health Professions 26:13-24 24

25. Outline for the discussion • Knowledge Translation at CIHR • Definitions, purpose and rationale for knowledge translation • How widely can the concept of knowledge translation be applied? • But what does KT really mean? • Knowledge to Action – Graham et al 2006 • Knowledge Translation – good in theory - how can it work in practice? • How to measure the impact of Knowledge Translation • Moving knowledge to action: Best practice for wound care 25

26. Knowledge to Action – Graham et al 2006 Knowledge to Action Cycle 26

27. Knowledge to Action – Graham et al 2006 • How was this model derived? • The Knowledge Creation “funnel” • The Action Cycle 27

28. Knowledge to Action – Graham et al 2006 • How was this model derived? • The Knowledge Creation “funnel” • Importance of synthesis • To contextualize and integrate the findings of an individual research study within a larger body of literature. • Synthesis can take the form of a systematic review, or follow the methods developed by the Cochrane Collaboration, or use quantitative or qualitative methods or result from a consensus conference or expert panel. 28

29. Knowledge to Action – Graham et al 2006 • How was this model derived? • The Knowledge Creation “funnel” • Importance of systematic reviews • Used to create knowledge tools ie provide the data content for incorporation in practice guidelines • Used to determine best practice (that needs to be implemented) • To create a context for and establish an evidence base for the knowledge to be translated 29

30. Knowledge to Action – Graham et al 2006 • How was this model derived? • The Knowledge Creation “funnel” • Importance of grading evidence within systematic reviews • Establishes the credibility of the evidence base of the knowledge to be “translated” • Creates a hierarchy of types of evidence to guide the synthesis of knowledge 30

31. Knowledge to Action – Graham et al 2006 • How was this model derived? • 2. The Action Cycle • First – a lesson on implementation theories; • Classical: passive descriptive models- (normative) eg. diffusion theory – used to retrospectively understand change • Planned: action models – designed specifically to be used to bring about change 31

32. Knowledge to Action – Graham et al 2006 • One example of a planned action theory/framework: • The Ottawa Model of Research Use (OMRU) • About moving research findings/evidence into practice • There are other good models – this is just an example 32

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34. Knowledge to Action – Graham et al 2006 • Action categories derived from the constructs of all the planned action theories we reviewed: • Identify the problem • Identify the need for change • Identify change agents • Identify target audience • Assess barriers • Review evidence/ literature or develop innovation 34

35. Knowledge to Action – Graham et al 2006 • Action categories continued… • Tailor/develop intervention • Link(age) • Implement • Evaluate • Develop evaluation plan • Pilot test • Evaluate the process • Evaluate outcomes • Maintain change • Disseminate 35

36. Knowledge to Action – Graham et al 2006 Knowledge to Action Cycle 36

37. Outline for the discussion • Knowledge Translation at CIHR • Definitions, purpose and rationale for knowledge translation • How widely can the concept of knowledge translation be applied? • But what does KT really mean? • Knowledge to Action – Graham et al 2006 • Knowledge Translation – good in theory - how can it work in practice? • How to measure the impact of Knowledge Translation • Moving knowledge to action: Best practice for wound care 37

38. Knowledge Translation – good in theory - how can it work in practice? • Who is responsible for what in the knowledge translation process? • Depends on the particular situation • The key process to keep in mind is linkage/communication with key stakeholders • In cases where implementation (knowledge to action) is required, ensure agreement on: • the need for change • the evidence for change • methods and the evaluation of the impact of the change • as well as who should do what… 38

39. Knowledge Translation – good in theory - how can it work in practice? • In what ways can researchers best contribute to the KT process? • They can: • contribute to the science as well as the practice of KT • conduct needs assessments • conduct systematic reviews pointing to a need for change • create an appetite for research results • keep communication lines open • conduct research with a ready audience having a perceived need for the research results • be knowledge brokers • be systematic and rigorous 39

40. Knowledge Translation – good in theory - how can it work in practice? • Role of consumers in knowledge translation • How they can contribute depends on their role – are they on the receiving end or are they the drivers of change? • In Canada there are many examples of vocal lobby groups driving political agendas – ie pro choice, gay marriage, HIV/AIDS research • At CIHR, for example – the Institute for Musculoskeletal Health and Arthritis (IMHA) involves consumers in a number of different ways 40

41. Outline for the discussion • Knowledge Translation at CIHR • Definitions, purpose and rationale for knowledge translation • How widely can the concept of knowledge translation be applied? • But what does KT really mean? • Knowledge to Action – Graham et al 2006 • Knowledge Translation – good in theory - how can it work in practice? • How to measure the impact of Knowledge Translation • Moving knowledge to action: Best practice for wound care 41

42. How to measure the impact of Knowledge Translation • How to measure impact is the six million dollar question – whether it is framed to be about the KT process or the impact of KT • Depends on one’s definition and on the perspective of the stakeholder • Can develop measures of each step of the K to A process, but there is no empirical data to suggest how to weight the various components • Can assess degree of activity or linkage or use of knowledge at each of the steps 42

43. How to measure the impact of Knowledge Translation • Need to consider types of impact: • instrumental (applying research results in specific, direct ways), • conceptual (using research results for general enlightenment, results influence actions but more indirectly and less specifically than in instrumental use) or • symbolic (using research results to legitimate and sustain predetermined positions)3 • 3 Beyer, J.M. 1997. Research utilization: Bridging the gap between communities. Journal of Management Inquiry 6 (1): 17-22. 43

44. How to measure the impact of Knowledge Translation • Canadian Health Services Research Foundation (CHSRF), and the Alberta Heritage Foundation for Medical Research (AHFMR) have been making some progress on the question of assessing impact, as has CIHR • CIHR has developed a framework for evaluation of the impact of the research we fund4 • 4 Developing a CIHR Framework to Measure the Impact of Health Research http://www.cihr-irsc.gc.ca/e/153.html 44

45. How to measure the impact of Knowledge Translation 45

46. How to measure the impact of Knowledge Translation 46

47. How to measure the impact of Knowledge Translation • Examples of sources of data for measuring impact of knowledge translation • Citation impact analyses (e.g. bibliometric studies) • End-of-Grant reports • Case studies • Interviews/surveys • Administrative data bases • Document analysis 47

48. Outline for the discussion • Knowledge Translation at CIHR • Definitions, purpose and rationale for knowledge translation • How widely can the concept of knowledge translation be applied? • But what does KT really mean? • Knowledge to Action – Graham et al 2006 • Knowledge Translation – good in theory - how can it work in practice? • How to measure the impact of Knowledge Translation • Moving knowledge to action: Best practice for wound care 48

49. Moving knowledge to action: Best practice for wound care • 7 year program of research and implementation • Led by Ian Graham and Margaret Harrison5 • Community care of venous leg ulcers • Collaborative interdisciplinary approach • Excellent means of illustrating the knowledge to action cycle • 5A community-researcher alliance to improve chronic wound care • CIHR KT Casebook, (Graham et al, 2006) • http://www.cihr-irsc.gc.ca/e/30669.html 49

50. Knowledge Creation Knowledge inquiry Knowledge synthesis Knowledge tools/ products Tailoring knowledge Monitor knowledge use Select, tailor implement interventions Evaluate outcomes Assess barriers to knowledge use Sustain knowledge use Adapt knowledge to local context Identify Problem Identify, Review Select knowledge 50